Provider Demographics
NPI:1497705107
Name:MANN, NANCY M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:MANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-0940
Mailing Address - Country:US
Mailing Address - Phone:203-245-0513
Mailing Address - Fax:
Practice Address - Street 1:50 WILSHIRE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3350
Practice Address - Country:US
Practice Address - Phone:203-245-0513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001403101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001403OtherDEPT OF PUBLIC HEALTH
CT197830OtherMHN
CT024740000OtherMAGELLAN FOR CHN
CT11495223OtherCAQH
CT329553OtherVALU OPT CHN CT SAGA
CT001403OtherDEPT OF PUBLIC HEALTH